Gastroenterology: Malrotation Flashcards
When does it usually present?
The first few days of life
But can be seen at a later age
How does it occur?
During rotation of the small bowel in foetal life, if the mesentery is not fixed at the duodenojejunal flexure or in the ileocaecal region, it’s base is shorter than normal and is predisposed to volvulus
What are Ladd bands?
Peritoneal bands that may cross the duodenum, often anteriorly
What are the 2 presentations?
Obstruction
Obstruction with a compromised blood supply
What type of vomiting occurs?
Bilious
What does any child with dark green vomiting need?
An urgent upper GI contrast study to assess intestinal rotation, unless signs of vascular compromise present (urgent laparotomy needed)
Is it a surgical emergency?
Yes
Why is it a surgical emergency?
When a volvulus occurs the superior mesenteric arterial blood supply to the small intestines and proximal large is compromised - unless corrected will lead to infarction of these areas
What clinical features are present?
Bilious vomiting
Abdominal pain
Tenderness from peritonitis or ischaemic bowel
